Lege Artis Medicinae

[Inhibition of thrombocyte aggregation in patients with lower-limb vasoconstriction - Do we really treat them well?]

JÁRÁNYI Zsuzsanna

JUNE 20, 2011

Lege Artis Medicinae - 2011;21(06-07)

[Due to the prevalence and significant mortality of peripheral vascular diseases, their treatment requires special attention. PATIENTS - We examined 45 patients awaiting vascular surgery at the Department of Cardiovascular Surgery at Semmelweis University. RESULTS - We have demonstrated that the routine administration of acetylsalicylic acid was ineffective in the majority (60%) of patients, especially in the at-risk groups. In contrast, clopidogrel therapy was ineffective in only 11% of patients. CONCLUSIONS - On the basis of the literature and our own studies, we consider clopidogrel as the first-choice drug for the inhibition of thrombocyte aggregation in all patients with vascular disease, and for primary prevention in at-risk groups.]

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Lege Artis Medicinae

[Committed physicians, emotional resonance for a better physician-patient relationship]

LAZÁNYI Kornélia, SZLUHA Kornélia

[With the advent of holistic medicine in the second half of the 20th century, the range of behavioural patterns that are expected from healthcare workers has also changed. Nowadays, numerous references in literature put emphasis on the potential positive impact of personal interactions between physician and patient on the healing process and overall well-being of patients. However, it does not come naturally to all workers with caring professions to seek personal interactions with their patients or display appropriate emotions. Some will have to make deliberate efforts, perform emotional labour, to achieve that goal. A healthcare worker’s commitment to healing and caring may make it easier for him/her to perform emotional labour. Emotional labour and commitment of 84 healthcare workers involved in oncology, and organizational factors with impact thereupon, were studied to explore the potential relationship between commitment and emotional labour. PANAS-X questionnaires were used to quantify emotional labour, while commitment and influencing factors were surveyed by means of explicative questions. Our findings confirmed a correlation between commitment and genuine acting as corroborated by literaure data. It was demonstrated that committed healthcare workers’ spontaneous emotions were more in compliance with what their patients expected them to display, and even their behavioural patterns were more in tune with the patients’ expectations. Confirmation as an organizational factor and colleague/ patient attitudes were found to have the strongest impact on commitment. It is essential that selection criteria for healthcare workers include examination for an altruistic caring attitude. Even more importantly, operators and managers of healthcare institutes should make efforts to create a good working environment and offer regular confirmative feedbacks for improved commitment by their employees.]

Lege Artis Medicinae

[Changes in infectology over the past two decades]

SZALKA András

[Infectious diseases and various infections are the major causes of morbidity and mortality in developing as well as in industrialised countries. Despite the advances in the past decades in our understanding of microbes, efficient treatment of diseases and preventive approaches, more than 13 million people die every year due to infectious diseases. In the past two decades, more and more new pathogens and infections diseases have been emerging and old diseases that were almost forgotten have re-emerged. There are many new diseases for which we do not have or have hardly any efficient antimicrobial drugs and no efficient vaccines. Despite an increasing frequency of multi- and panresistant microbes, the development of new antibiotics to be used against these infections is unlikely to occur in the near future. The big pharmaceutical companies have stopped the research of antibiotics. In this situation, the only option we have is to use antibiotics rationally and to take prevention and control of infections seriously, both in the outpatient system and in hospitals. Preserving the effectiveness of currently used antibiotics is in everyone’s interest and is everyone’s responsibility.]

Lege Artis Medicinae

[Financial waltz around an imagined patient]

LIPTÁK Judit, TARCZA Orsolya

Lege Artis Medicinae

[A new approach to the treatment of diabetic retinopathy - PPAR-α agonist activity of fenofibrate]

CSÁSZÁR Albert

[Diabetic retinopathy (DR) is a leading cause of visual impairment worldwide. It affects nearly half of patients with diabetes and its severity increases with the progress of diabetes. Glycotoxicity, lipotoxicity and hypertension are the main risk factors for the development of DR. The control of glucose homeostasis and blood pressure are the main noninvasive approaches that might have a role in the treatment of this condition. On the basis of new studies, RAS inhibitors and fenofibrate are promising candidates that can be used to retard DR progression and/or induce its regression. Two large-scale studies (FIELD, ACCORD Eye) have demonstrated that fenofibrate therapy significantly reduces the need for laser treatment of DR. The efficiency of this therapy, which is independent of lipid changes, is primarily attributable to the PPAR-α agonist activity of fenofibrates. According to guidelines that discuss the new therapeutic approaches of DR, fibrate therapy is a promising new option for preventing the progression of DR.]

Lege Artis Medicinae

[At the Forefront of Modern Art: The Eight Painters]

NEMESI Zsuzsanna

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[An analysis of the ankle-brachial index in patients with diabetes in general practice]

GALVÁCS Henrietta, HASITZ Ágnes, BALOGH Zoltán

[INTRODUCTION - Diabetic macroangiopathy is one of the most prevalent complications of chronic diabetes mellitus. In Hungary, diabetic foot diseases and atherosclerosis are the most common causes of lower limb amputations. In this paper, we aim to present the correlations between the ankle-brachial index in patients with diabetes mellitus, and risk factors such as HbA1c levels, smoking and gender, in order to prevent atherosclerosis and to facilitate its rapid diagnosis. PATIENTS AND METHODS - Ankle-brachial index (ABI) of diabetic patients was measured and statistically analysed. Our goal was to determine potential correlations between ABI and the three above mentioned risk factors. The study population consisted of patients with a known history of diabetes mellitus (n=65) who visited the general practitioner's office between July 2015 and September 2016. RESULTS - 47.69% of patients exhibited a pathological ankle-brachial index. The ankle-brachial index showed a statistically significant correlation with gender (p=0,054). There was no significant correlation between the ankle-brachial index and smoking (p=0.838) or between the ankle-brachial index and HbA1c levels (p=0.430). CONCLUSION - Our research suggests that primary care physicians should regularly assess the ankle-brachial index in diabetic patients as preclinical atherosclerosis is frequently present in this population. Regular screening can facilitate early diagnosis and reduce the risk of severe macrovascular complications.]

Lege Artis Medicinae

[Clinical impact of acetylsalicylic acid resistance in patients with cerebrovascular disease]

FEHÉR Andrea, PUSCH Gabriella, HARANG Gábor, GASZTONYI Beáta, PAPP Előd, WERLING Dóra, MENYHÁRT Marianna, KOMÁROMY Hedvig, SZAPÁRY László, FEHÉR Gergely

[INTRODUCTION - In the past few years, a number of studies have been published about acetylsalicylic acid resistance and its potential clinical consequences. PATIENTS AND METHODS - 281 patients with chronic cerebrovascular disease have been involved in our study. The patients were divided in two groups on the basis of their optical aggregometer results (acetylsalicylic acid responder vs. resistant). We compared the risk profiles, drug therapies, laboratory parameters and clinical outcomes of the two groups. RESULTS - Acetylsalicylic acid resistant patients were more likely to be women [23 (45.1%) vs. 92 (40%) (p<0.05)], to smoke (38% vs. 25%), have hypertension (92 vs. 78%), hypercholesterolaemia (5.69 vs. 4.85 mmol/l), and elevated LDL-levels (3.71 vs. 2.85 mmol/l), triglyceride levels (2.78 vs. 1.97 mmol/l) and hsCRP levels (17.89 vs. 7.09 mmol/l) (p<0.01). The use of statins was more frequent (56% vs. 36%) in the responder group (p<0.01). Platelet aggregation values (triggered by agonists) were significantly correlated with cholesterol, LDL, triglyceride and hsCRP levels (p<0.05). Adverse outcomes were reached in 13 (25.5%) acetylsalicylic acid nonresponders and 32 (13.9%) acetylsalicylic acid responder patients (p<0.01). In a multivariate analysis, however, only smoking (OR: 2.38, CI: 1.77-5.44) and increased LDL (OR: 3.01, CI: 2.34-5.67) and hsCRP levels (OR: 2.44, CI: 1.55-7.02) (p<0.05) were independent risk factors of adverse vascular outcomes. CONCLUSION - On the basis of our results, acetylsalicylic acid resistance was associated with a worse clinical outcome, but it was not an independent risk factor of future ischaemic events. Our results implicate that inappropriate prevention therapy might have a role in this phenomenon.]

Lege Artis Medicinae

[Acetylsalicylic acid (ASA) 75 or 100 mg? ]

KIS János Tibor, ZSIGMOND Kálmán

[The acetylsalicylic acid (ASA) is one of the oldest and most widely used drugs in the world. Currently, it is the most commonly used for the treatment and prophylaxis of cardiovascular diseases. Today, there has been consensus that the risk of ASA’s side effects in primary prevention is greater than the expected benefits. However, it maintains its leading role in the secondary prevention of cardiovascular diseases. There is also a consensus that small doses are recommended for preventive purposes, but there is no agreement whether it should be 75 or 81 or 100 mg. The authors summa­rize the publications published in this topic. ]

Lege Artis Medicinae

[NSAID-ASSOCIATED GASTROPATHY: RECENT ASPECTS OF PREVENTION]

HERSZÉNYI László

[Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs worldwide. Gastroduodenal ulcers are found at endoscopy in 15 to 30% of patients who use NSAIDs regularly. The annual incidence of severe upper gastrointestinal complications such as bleeding or perforation is 1.0 to 1.5%. From a cost-benefit perspective, prevention strategies should consider both gastrointestinal, and recently, cardiovascular risk factors. No prophylaxis is necessary with low gastrointestinal risk. There are currently four possible strategies to reduce the risk of adverse gastrointestinal effects: 1. the use of selective COX-2 inhibitors or coxibs rather than traditional NSAIDs; 2. cotherapy, primarily with proton pump inhibitors, to ensure protection to gastric mucous membrane; 3. co-therapy with a coxib and a proton pump inhibitor in patients with very high risk (eg., history of bleeding); 4. eradication of Helicobacter pylori infection in patients with a history of ulcer. The use of coxibs decrease the risk of gastrointestinal damage by roughly 50%. In the presence of gastrointestinal risk factors or for patients on aspirin also treated with an NSAID or a coxib, protection with a proton pump inhibitor is recommended. Proton pump inhibitor therapy is also useful for the prevention and treatment of NSAID-induced dyspepsia. The beneficial effects of proton pump inhibitors cannot solely be explained by their profound antisecretory action. Therefore, several acid secretion- independent mechanisms of action have been proposed.]

Lege Artis Medicinae

[Mechanism of action and role of cilostazol in treatment of peripheral arterial disease]

KOLTAI Katalin, BIRÓ Katalin, KOVÁCS Dávid, CSISZÁR Beáta, TÓTH Kálmán, KÉSMÁRKY Gábor

[Intermittent claudication is a typical symptom of lower extremity arterial disease. Cilostazol is a reversible, selective phosphodiesterase-3 inhibitor which has antiplatelet, antithrombotic and vasodilator effects. It is indicated to improve maximal and pain-free walking distance in patients with intermittent claudication in the absence of rest pain or peripheral tissue necrosis. It can be beneficial in diabetic patiens with intermittent claudication, as it has been proved to prevent the development of foot ulcers. In combination with acetyl-salicylic acid it may help maintain stent patency after endovascular intervention and stent implantation. Cilostazol is contraindicated in heart failure. With cilostazol, a clinically proven effective drug has become available in the treatment of intermittent claudication which could improve walking and life quality of patients.]